NJDEP

Community Right To Know Fee Exemption Request Form

*Company Name:
*FEIN (Federal Employer Identification Number):
*Mailing Address: Street Address, City, Zip	City State: Zip
*Physical Address: Street Address, City, Zip	City State: Zip
*Contact Name:
*Phone Number :
*Email Address:
*Reason for Fee Exemption (Check All That Apply): Administrative Office Only No Facility in New Jersey Non User of Environmental Hazardous Substances Incorrect NAICS Code Must Indicate Correct Six Digit Code See https://www.census.gov/naics/ Exempt NAICS Subcategory Code Company Out of Business Other Explain:
* Required Fields